REGISTRATION: Please print and mail completed form for each person/boat.
After July 12, please call 319-752-1857 or 1-800-RIVER-12 with credit card and the below information.

YES, I WANT TO PADDLE the SKUNK 2010 - JULY 17, 2010

Name ___________________________________________Age ________

Address __________________________________________________

City, State, Zip______________________________________________

Phone (day)____________________ (eve)___________________(cell)________________

E:mail (please print clearly)_________________________________________

second person:

Name ___________________________________________Age ________

Address __________________________________________________

City, State, Zip______________________________________________

Phone (day)______________________ (eve)___________________(cell)_________________

E:mail (please print clearly)_________________________________________
I recognize that there is an element of risk in any outdoor activity. Knowing of the inherent risks, dangers and rigors, I certify that I and my family are fully capable of participating in this paddle trip. I assume full responsibility for my personal property and expenses while participating in this event. I agree to hold harmless River Basin Canoe & Kayak. I also give River Basin Canoe & Kayak permission, without limitation, to use any photographs that might be taken of me while participating in this event.

Signature ______________________________________________ Date _______________________

Signature ______________________________________________ Date _______________________

Registration Fee

____# participants @ $20……………………….…………… $______

____# canoe rentals @ $60 includes 2 adult registrations............$______

____# kayak rentals (call for prices)…………………………. $______

____# lunches @ $7 (sandwich, chips, fruit) ………………… $______

Total amount enclosed ...................................................$____________Please add 7% tax

NON-REFUNDABLE. THE EVENT WILL BE HELD RAIN OR SHINE.
We reserve the right to cancel the trip in case of dangerous water conditions. If we cancel the trip you will be refunded.

Mail check or money order and completed form to:
River Basin Canoe & Kayak
13038 Hwy 61 North
Burlington, IA 52601
If you prefer to pay by credit card and e:mail us the registration, please call with your card info. Do not e:mail it!